Russell Loyd Henderson, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

201401588NP-PP Issued in OR

Practice address

595 SW Bluff Dr Ste a
Bend, OR 97702

Phone

(541) 728-2063

NPI assigned

Jan 16, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Icco, LLC

  • Urgent Care Clinic/Center
  • Eugene, OR
  • NPI 1407004757
  Medicare reassignment NPD
• Icco LLC

  • Rural Health Clinic/Center
  • Florence, OR
  • NPI 1740896547
  NPD
• Omhc, LLC

  • Clinic/Center
  • Bend, OR
  • NPI 1356848352
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1336486943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70673",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974750133",
            "telephone_number": "541-248-9556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 SW BLUFF DR STE A",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "541-728-2063"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 N Madison",
            "address_purpose": "LOCATION",
            "city": "Pittsfield",
            "state": "IL",
            "postal_code": "62363",
            "country_code": "US",
            "telephone_number": "217-285-9601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 Coburg Rd",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974014995",
            "country_code": "US",
            "telephone_number": "541-255-3233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "RUSSELL",
        "middle_name": "LOYD",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-16",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201401588NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anita Ruth Henderson, MD
• Erin Henderson, PT
• Jessica Ann Henderson, DMD
• Mike Daniel Henderson, D.O.
• Robin J Henderson, PSYD
• Sidney E Henderson III, M.D.
• Stephanie Henderson
• Sylvia Dianne Henderson, LPC
• Tracy Renee Henderson
• Valerie Rose Henderson

• Family Nurse Practitioner in Bend, OR
• Providers in Bend, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.